Agbozo Faith, Abubakari Abdulai, Der Joyce, Jahn Albrecht
Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe campus, Ho, Ghana; Institute of Public Health, Medical Faculty, University of Heidelberg, Germany.
Institute of Public Health, Medical Faculty, University of Heidelberg, Germany; Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.
Midwifery. 2016 Sep;40:200-6. doi: 10.1016/j.midw.2016.06.016. Epub 2016 Jun 25.
birth weight is vital to the development potential of the newborn. Abnormal birth weight (such as low birth weight and macrosomia) is an important determinant of child survival, disabilities, stunting, and long-term adverse consequences for the onset of non-communicable diseases in the life course and therefore demands appropriate public health interventions. Stillbirths are also considered one of the most important, but most poorly understood and documented adverse outcomes of pregnancy. Therefore, this study aimed to assess the prevalence of abnormal birth weight and related maternal risk factors, as well as pregnancy outcomes, such as stillbirth.
a retrospective study design was used to analyze 4262 delivery records for singleton pregnancies from January 2013 to December 2014 seen at the Hohoe municipal hospital, Volta region in Ghana. The data on birth weight and related factors were derived from the delivery book. Data was analyzed using STATA. Multinomial logistic regression was used to assess the association between maternal factors such as parity, age and intermittent preventive treatment of malaria, sex of infant and abnormal birth weight. Association between stillbirth and related factors was assessed using logistic regression.
prevalence of low birth weight (<2.5kg) was 9.69% and macrosomia (≥4.0kg) was 3.03%. There was an increased risk of a first born being of low birth weight than second or third born (RR; 2.04, CI; 1.59-2.64, p<0.0001). There were also an increased risks of mothers <20 years giving birth to low-birthweight infants (RR; 1.46, CI; 1.11-1.93, p=0.007) compared to mothers who were within the age ranges of 20-30 years and also among those who took only one (RR; 1.57, CI; 1.02-2.39, p=0.039) or no intermittent preventive treatment for malaria during pregnancy (RR; 1.57, CI; 1.24-1.98, p=<0.0001) compared to those who took three doses. Risk of macrosomic birth was particularly high among 5th born (RR; 2.66, CI; 1.43-4.95, p=0.002) compared to first or second born. Stillbirth rate was 27/1000 births. Thirty-two percent of the stillbirths (n=38) had low birth weight whereas 6.8% (n=8) were macrosomic. There was a greater than fivefold (AOR; 5.6, CI; 3.6-8.7) and greater than twofold (AOR; 2.4, CI; 1.1-5.3, p=0.025) increase in odds for stillbirth among low birth weight and macrosomic infants respectively.
macrosomia and low birth weight co-existed among infants in Hohoe municipality, both of which are associated with adverse pregnancy outcome such as stillbirth. Given the apparent association between maternal age <20 years and increased risk, health promotion strategies aimed at preventing pregnancies among teenagers could be implemented to aid the reduction of stillbirth rates.
出生体重对新生儿的发育潜力至关重要。异常出生体重(如低出生体重和巨大儿)是儿童生存、残疾、发育迟缓以及生命历程中患非传染性疾病长期不良后果的重要决定因素,因此需要适当的公共卫生干预措施。死产也被认为是妊娠最重要但了解和记录最少的不良结局之一。因此,本研究旨在评估异常出生体重的患病率及相关的孕产妇风险因素,以及妊娠结局,如死产。
采用回顾性研究设计,分析了2013年1月至2014年12月在加纳沃尔特地区霍霍埃市立医院的4262例单胎妊娠分娩记录。出生体重及相关因素的数据来自分娩记录册。使用STATA软件进行数据分析。采用多项逻辑回归评估诸如产次、年龄和疟疾间歇性预防治疗等孕产妇因素、婴儿性别与异常出生体重之间的关联。使用逻辑回归评估死产与相关因素之间的关联。
低出生体重(<2.5kg)的患病率为9.69%,巨大儿(≥4.0kg)的患病率为3.03%。头胎出生低体重的风险高于二胎或三胎(相对危险度;2.04,可信区间;1.59 - 2.64,p<0.0001)。与年龄在20 - 30岁的母亲相比,年龄<20岁的母亲生育低体重婴儿的风险也增加(相对危险度;1.46,可信区间;1.11 - 1.93,p = 0.007),而且与孕期接受三次疟疾间歇性预防治疗的母亲相比,仅接受一次(相对危险度;1.57,可信区间;1.02 - 2.39,p = 0.039)或未接受疟疾间歇性预防治疗的母亲生育低体重婴儿的风险也增加(相对危险度;1.57,可信区间;1.24 - 1.98,p<0.0001)。与头胎或二胎相比,五胎出生巨大儿的风险特别高(相对危险度;2.66,可信区间;1.43 - 4.95,p = 0.002)。死产率为27/1000例分娩。32%的死产(n = 38)为低出生体重,而6.8%(n = 8)为巨大儿。低出生体重和巨大儿的死产几率分别增加了五倍多(调整后比值比;5.6,可信区间;3.6 - 8.7)和两倍多(调整后比值比;2.4,可信区间;1.1 - 5.3,p = 0.025)。
霍霍埃市的婴儿中存在巨大儿和低出生体重情况,二者均与死产等不良妊娠结局相关。鉴于年龄<20岁的母亲与风险增加之间存在明显关联,可实施旨在预防青少年怀孕的健康促进策略,以帮助降低死产率。